Provider Demographics
NPI:1144393604
Name:STEPHEN D RAINES
Entity Type:Organization
Organization Name:STEPHEN D RAINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:731-885-0220
Mailing Address - Street 1:1415 E REELFOOT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5812
Mailing Address - Country:US
Mailing Address - Phone:731-885-0220
Mailing Address - Fax:731-885-0216
Practice Address - Street 1:1415 E REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5812
Practice Address - Country:US
Practice Address - Phone:731-885-0220
Practice Address - Fax:731-885-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000217213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3350895Medicaid
KY7100025780Medicaid
TN3717524Medicaid
TN1548228620OtherNPI
TN1962618488OtherDME NPI
TN1568496172OtherNPI
TN3354276Medicaid
TN3354276Medicare ID - Type Unspecified
KY7100025780Medicaid
TNV10699Medicare UPIN
TNT61077Medicare UPIN
TN3354276Medicaid
TN3717524Medicaid